| Organization Name: | IMMOKALEE FAMILY DOCTOR'S CLINIC, LLC |
| NPI Number: | 1801157839 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUAN RIGOBERTO PUERTO (OWNER) |
| Mailing Address: | 555 N 15th St Suite A Immokalee |
| State: | FL US |
| Postal Code: | 341422854 |
| Phone Number: | 2396572779 |
| Fax Number: | 2396573335 |
| NPI Enumeration Date: | 06/06/2012 |
| NPI Last Update Date: | 06/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME42490 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |